Finding joy in someone else's misery can be tricky

It's not every day that reporters and pundits get to use a word like "schadenfreude," so when the opportunity arises, quite a few grab it.

That's why you've probably heard or read more than once lately about Republican schadenfreude over Obamacare. Talk about easy targets: Even Democrats admit that the rollout of HealthCare.gov, the federal health insurance exchange, has been a monumental screwup.

Feeding the Republicans' delight at President Barack Obama's misfortune are polls showing the public's view of the Patient Protection and Affordable Care Act growing sourer by the day. Take the Kaiser Health Tracking Poll. After nearly two years of relatively stable results, the survey took a sharp turn in November; those who have a favorable opinion of the ACA fell to 33 percent--lower than at any time since passage of the law--while nearly half of respondents said they now have a unfavorable view of the law.

But finding joy in others' misery can come back to bite you. Sure, there's little risk for Republicans as long as most Americans want to fume about Obamacare but stop short of asking Congress to get rid of it. But if polls suddenly showed a majority favoring repeal, then what?

One option would be a return to the status quo ante, but let's think for a moment about what that would mean. Remember, the main impetus for health care reform was the spiraling, unsustainable increase in costs over recent decades. Add to that the millions of uninsured Americans and quality-of-care concerns.

Those who think we were doing just fine before should take a look at the Commonwealth Fund's newly released annual comparison of health care systems in more than a dozen developed nations. In 2011, health care spending per capita in this country totaled $8,508. Norway was second highest, at $5,669--one-third less--and six of the 14 countries spent less than $4,000 per capita. In a range of other per-capita measures, including out-of-pocket health care spending and hospital expenditures, the United States also was sharply higher.

Spending more to achieve better outcomes might make sense, but that's not the case. The number of practicing physicians per 1,000 population is lower here than in nearly all of the other countries; obesity prevalence is considerably higher; access to same-day/next-day appointments when sick is second-worst; the incidence of medical errors also is second-worst; and the avoidable-deaths rate is highest. All this, while universal health care coverage is the norm elsewhere.

Another new report, from the Organization for Economic Cooperation and Development, has similar findings. In life expectancy, the United States ranks 26th of 36 OECD countries.

By some measures, U.S. health care performance is respectable or even good. The mortality rate after admission for heart attack is an example of the former, while the five-year breast cancer survival rate falls into the latter category, according to the Commonwealth Fund data. But overall, the return on health care spending here is poor.

The other option would be to replace Obamacare with another remedy. The most common model found in other countries is the single-payer system, but conservative foes of the ACA won't go there. The fix some congressional Republicans have proposed--detailed in the American Health Care Reform Act, introduced in September--is a "market-based, common-sense" approach tailored to give each of us the opportunity to choose a health plan that fits our needs. But how, exactly? Well, chiefly by getting rid of the tax break for employer-based plans that currently account for more than 50 percent of covered Americans, replacing it with a standard deduction.

Earlier GOP proposals have included state-based exchanges that guarantee access to coverage and care. Wait, isn't that we have in New York now under the ACA?

I'm not saying a market-based system is a dumb idea; some aspects have real merit. But why not also acknowledge that in some key respects the 2010 health care law embodies what conservatives long supported-the individual mandate, for example--until it became Obama's signature legislation?

And while we're being honest, might we all agree that any reform plan which truly targets what ails the U.S. health system will be disruptive, requiring many of us to do things differently than before?

Schadenfreude is more fun, for sure. So is loose talk about repealing Obamacare, though here's what Steven Goldstein, vice president of the University of Rochester Medical Center and CEO of Strong Memorial and Highland hospitals, had to say about that at the recent RBJ Power Breakfast on health care reform: "The law is here to stay."

If that's the case, why not focus on improving the ACA? Not a lot of "freude" in that, I'll admit. But it probably would be better for us.